Preparing for the Business of Radiology: A Nontraditional Approach

One physician’s path from management consultant to radiology resident

Alexander Misono, MD, MBA is a radiology resident at Massachusetts General Hospital, but he’s already switched careers. After a stint in management consulting, Misono changed course and headed to medical school. The Bulletin caught up with Misono to discuss the areas of overlap in radiology and business and the various paths to gaining business experience in a medical context.

Please tell us about your business background.

My business background is primarily in management consulting. Although I did not specifically study business in college, I entered the consulting industry after graduating. I started out with a few years as a full-time consultant at LEK Consulting, working on behalf of biotechnology, pharmaceutical, and medical device companies. I worked on projects ranging from drug development strategy to mergers and acquisitions.

The hours were rough; sometimes we worked past midnight seven days a week to complete a project. But the projects were often rewarding.

For example, I worked closely with teammates on a deal in the biological research space. Our role was to understand the standalone value of the acquisition target and potential synergies after a merger. It was exciting to watch a $1.4 billion deal be announced within days of our blessing. As a consultant, I learned how to work in high-pressure situations on tight-knit teams, think strategically, execute complex analyses, and compose arguments clearly.

I came to know medicine very well as a consultant in the biotech/pharma space, as I often interacted with both thought leaders and community physicians treating a variety of diseases. That, along with numerous other factors outside of scope of this conversation, meant that the transition to medical school came rather naturally, as did, of course, an MBA.

During my MD/MBA, I continued work in biotech/pharma, working with several biotechnology companies in Boston (Biogen, Syntonix, and BIND, for example) on product, portfolio, corporate strategy, and mergers and acquisitions. I enjoyed the coursework involved in the MBA (especially topics such as finance, strategy, and negotiations), but I found I learned most from the diverse experiences of my classmates, who came from innumerable industries, disciplines, and geographies.

After my MD/MBA, I returned to consulting for a short stint prior to residency, as a sort of “postdoc” for business training. At the Boston Consulting Group, I focused primarily on high-impact strategy work for pharmaceutical, payer/provider, and global health institutions. Projects included research and development acceleration strategy for the Bill and Melinda Gates Foundation and a vaccine partner, growth strategy for a specialty pharmaceutical company facing competitive pressures, and health information technology assessments for one of the nation’s largest managed care consortiums.

And now, I’m a resident!

How does your business background help you as a radiologist?

Business experiences do not inherently assist in interpretation of images or clinical skills involved with intervention. However, I have already leaned on my experiences heavily in nearly all other facets of my radiology life.I am interested in understanding the financial underpinnings of the business of radiology, because I believe that only by doing so can one truly optimize value for patients and the health care system. After all, we must deliver the best care while not bankrupting patients, health systems, or the country. For example, theJournal of Vascular and Interventional Radiology will soon publish some work that we performed regarding financial modeling for optimizing inpatient interventional radiology consult services.

I also find business experience to be invaluable when it comes to organized medicine and radiology. I am involved with both ACR and SIR and trying my best to contribute in meaningful ways. I became rapidly interested in these organizations because of the work they do on behalf of radiologists, constantly trying to prove our value to the outside world. In my various roles with these organizations, I find that my prior experiences are often integral if not instrumental in my ability to contribute. Whether running meetings, helping to analyze issues facing our profession, or preparing presentations, these are mostly bread and butter business skills. As my career moves forward, I aspire to remain an active member of organized radiology and continue to pursue research focused on the intersection of radiology and business. Perhaps one day I will be able to fill operational, strategic, or leadership roles within my future practices.

Any advice for trainees interested in a business education?

Pursuing an MBA after residency or trying a stint in management consulting or another business-related professional services field is quite an undertaking. Pursuing an MBA first requires the GMAT, rigorous applications, and interviews. And then one is rewarded with two full years of a relatively expensive education. Consulting may at first seem more palatable, but jobs are scarce and the lifestyle is more akin to an intern than a resident. The opportunity cost of such a job may also be difficult to swallow, especially when compared with the earning potential of an attending radiologist. I recommend these kinds of paths to certain individuals who know exactly how they would use their time as a student or consultant.

I would otherwise advise trainees interested in the business side of radiology to peruse the various resources provided by the ACR, especially via the Radiology Leadership Institute® (RLI). There is plenty of on-demand content ready to be devoured by those interested. For those looking for a more rigorous approach, the annual RLI Summit is perhaps one of the best ways to get further exposure. There are scholarships to attend, and all are encouraged to apply.

How did your experience with the RLI compare to your MBA?

The RLI is conducted in conjunction with Babson College, one of the leading business schools in the country. As such, it may not be surprising that the RLI sessions led by Babson faculty felt nostalgically similar to my time in the MBA classroom. Furthermore, a group of motivated, highly intelligent, and savvy radiologists talking about business issues related to their practice is incredibly eye opening. Certainly, no MBA classroom could tackle the complexity of the issues we discussed at the RLI. It is a fantastic experience and I recommend it to anybody interested.